The virus is out there, and has been all summer, circulating at a low level through the five boroughs, turning up in samples sent to the city’s public-health lab, popping up at sleepaway camps, making a winter tour of the Southern Hemisphere, roaring back on college campuses in the South, and knocking on the door of New York City just as the school year began four weeks ago. And in what is known informally as an “epi shop,” on the second floor of a stolid prewar building on Worth Street, the epidemiologists of the city’s Department of Health and Mental Hygiene have been on the lookout, every day, for the return of H1N1.
“Where did the flu go?” Don Weiss, who heads the city’s disease-surveillance operation, asked over the summer. “It didn’t go anywhere. It’s been in the camps.”
Readers of The Hot Zone and other microbial potboilers may have a mental picture of epidemiologists as swashbuckling, khaki-pantsed techno-adventurers who routinely rush out into the wilderness—an outer borough, say—with cotton swabs and test kits, to corner and capture the latest killer virus. But in the real world of urban epidemiology, you get stuck in Friday-afternoon traffic, which is exactly what happened to Weiss’s team in April, as they rushed over to Queens for the glamorous task of collecting nasal drippings from teenagers at St. Francis Preparatory School, later dubbed the “epicenter of the swine flu outbreak” by local media.
As nerve centers go, Weiss’s office looks like it’s missing a few synapses. A single monitor sits on his otherwise neat desk; a brand-new set of surveillance sample kits (lunch containers purchased at Duane Reade) are on a nearby table. But looks are deceiving here, too. Every day, a tsunami of raw data washes through the Bureau of Communicable Disease. Around 8:30 or 9 a.m., the school numbers come in. Since the beginning of the school year, nurses have been reporting how many students visit their offices with flu symptoms, as well as attendance figures. Then come the hospital numbers: 50 hospitals send in their tally of patients seen for “influenza-like illness”—fever of 100-plus, with a sore throat or cough—in the prior 24 hours. The department also tracks cases that lead to hospital admissions and those that end up in intensive care. Every day, private laboratories send possible influenza samples to the city’s Public Health Laboratory, and each night, a large pharmacy chain (unnamed) sends in the day’s sales of prescriptions (like the antiviral drug Tamiflu) and over-the-counter medications for flulike symptoms. The city’s epidemiologists even get frequent reports using software that sifts through conditions that crop up in electronic medical records and 911 calls—“respiratory trouble” or “child with fever”—which can be analyzed by Zip Code. All this is basically a computerized way to look for patterns of disease that suggest when, and where, the virus is starting to cause problems. And so far, what have they seen?
“No, we haven’t seen [any problems with] H1N1,” confirmed Weiss, a compact, rapid-talking physician with a fringe of close-cropped gray hair. “What we’re seeing is what we would expect to see in a usual September,” he said last week. “Not that this is a usual September.”
Not at all. This intense round-the-clock surveillance represents New York City’s advance-warning system for an ambitious plan to deal with a health crisis that may never live up to its billing. On September 1, Mayor Bloomberg announced the city’s strategy for an expected return of H1N1. He was barely a minute into his remarks when he lapsed into the “yes, but” syntax that reflects the unpredictability of this flu: “There’s no indication that the virus will be more virulent than what we experienced in May and June, but we must have, and do have, contingency plans in case the virus becomes more widespread or more severe.”
In the meantime, ordinary New Yorkers have become intensely conversant about campus outbreaks on the West Coast, flu-infected turkeys in Chile, protesting health-care workers in Albany who are spooked by the swine-flu vaccine. If you listen out of one ear, it sounds like we could be on the cusp of the medical storm of the century; if you listen out the other, it sounds like H1N1 may be less of a threat than annual flu.
Either way, we may be finding out sooner rather than later. On September 18, the Centers for Disease Control and Prevention announced that the 2009–10 flu season in the United States had officially begun, and much of the country is experiencing what New York City lived through in the spring. The first shipments of swine-flu vaccine are expected to arrive in the city this week—a little earlier than first advertised, but with fewer doses than initially anticipated.